Last updated: April 2026
Most parents hear the word “crossbite” for the first time sitting in a pediatric dentist’s chair, watching their kid get a routine cleaning. The dentist says something vague like, “We might want an orthodontist to take a look at that bite.” That’s usually when the googling starts.
Here’s the short version. Braces alone sometimes fix a crossbite, and sometimes they don’t. It depends on whether the crossbite comes from tooth position (called a dental crossbite) or jaw width (called a skeletal crossbite), and on how old the patient is. A 7-year-old with a narrow upper jaw needs something different than a 30-year-old with a single tooth out of place. This guide walks through what a crossbite actually is, which treatments fix which kind, and what we do for crossbite cases at Tooth By Tooth in Cary.
What a Crossbite Actually Is
A crossbite is a bite misalignment (clinically called a malocclusion) where some upper teeth sit inside the lower teeth instead of outside them, which is the opposite of a normal bite. In a healthy bite, the upper teeth overlap the lowers slightly, like a lid on a box. In a crossbite, at least one upper tooth has slipped behind its lower counterpart.
There are two main types based on location in the mouth:
- Anterior crossbite. One or more front teeth. It can look like a small underbite limited to the front.
- Posterior crossbite. One or more back teeth. Can be on one side (unilateral) or both (bilateral). This is the most common type, present in roughly 4 to 17 percent of children according to a 2021 Cochrane review.
Crossbites generally don’t fix themselves. Left alone, they can cause uneven tooth wear, jaw shifting, and in some cases TMJ symptoms over time. The earlier they’re caught, the simpler the fix.
Do Braces Alone Fix a Crossbite?
Sometimes, yes. If a crossbite is caused by a tooth that’s tipped or positioned wrong, braces on their own can usually rotate and realign that tooth into the correct position. This is what’s called a dental crossbite.
If the crossbite is caused by the jaw itself being too narrow (a skeletal crossbite), braces can’t widen a jaw. You’ll need a palatal expander first, which is a device that gently widens the upper jaw by separating the mid-palatal suture. Then braces come after to align the teeth into the corrected position.
That distinction is the single most important thing to understand about crossbite treatment. The fix depends on what’s causing the crossbite, not just on the fact that one exists.
Dental vs. Skeletal Crossbite, and Why It Matters
This is where most online guides fall short. Lumping all crossbites together and saying “braces fix them” isn’t accurate. Here’s how the two types split:
| Factor | Dental Crossbite | Skeletal Crossbite |
|---|---|---|
| What’s misaligned | One or more teeth, tipped wrong | The upper jaw itself is too narrow |
| Common causes | Retained baby teeth, crowding, eruption path | Genetics, mouth breathing, thumb sucking, arch development |
| Treatment in kids | Braces, sometimes limited braces with bite blocks | Palatal expander, then braces |
| Treatment in adults | Braces or clear aligners | Surgically assisted expansion or jaw surgery in severe cases |
| Best age to treat | Any age, earlier is easier | Ages 7 to 12 (while jaw is still growing) |
| Typical duration | 6 to 18 months | Several months of expansion, then 12 to 24 months of braces |
The takeaway. If an orthodontist recommends braces only, without assessing whether the upper jaw is narrow enough to need expansion first, ask why. If an orthodontist wants to put an expander on a fully grown adult, get a second opinion. Once growth is complete, expansion alone usually isn’t enough.
Crossbite Treatment by Age
Age changes almost everything about the treatment plan, because the upper jaw’s mid-palatal suture starts fusing during the teen years. Before fusion, the jaw can be widened non-surgically. After fusion, it gets harder.
Ages 7 to 9 (the ideal window)
The American Association of Orthodontists recommends every child have an orthodontic evaluation by age 7. This is one of the main reasons why. At this age, we can spot a skeletal crossbite early, use a palatal expander over a few months to widen the jaw, and often avoid more complicated treatment later. For dental crossbites at this age, partial (limited) braces on a few teeth are sometimes all that’s needed.
This is also when we’d consider braces at age 7 if the situation calls for it. Not full braces on every tooth, but a targeted early treatment plan.
Ages 10 to 14 (still a strong window)
Most kids still have growth left, so expanders and Phase I orthodontics still work well. This is also the age when full braces are most commonly placed. If the crossbite is purely dental, we often skip the expander and go straight to braces. If it’s skeletal and growth is still happening, we start with expansion.
Ages 15 and up
Growth is mostly complete and the mid-palatal suture is fused or fusing. Treatment options shift:
- Mild dental crossbite. Braces or clear aligners can usually fix it.
- Moderate skeletal crossbite. Surgically assisted rapid palatal expansion (SARPE), which is a minor surgical procedure paired with an expander.
- Severe skeletal crossbite. Orthognathic (jaw) surgery combined with braces before and after.
Adults sometimes ask whether they should have had this fixed when they were younger. The honest answer is usually yes, but waiting doesn’t mean you’re out of options. It just means the options are narrower.
How Dr. Patel Treats Crossbites at Tooth By Tooth
At our Cary office, every crossbite evaluation starts with an intraoral scan, a clinical exam, and (for kids) a conversation about growth stage. Dr. Patel has been practicing orthodontics for over 12 years, with research published in the American Journal of Orthodontics and Dentofacial Orthopedics. The thing about crossbite cases is that two treatment plans can look identical on paper and produce very different results based on small chairside choices. That’s the part you can’t see in a marketing brochure.
Our typical workflow:
- Free consultation. You’ll see Dr. Patel personally. No associate, no rotating provider. He’ll examine the bite, show you what he sees on the scan, and explain whether the crossbite is dental, skeletal, or a mix.
- Treatment recommendation with options. If early expansion is warranted, we’ll say so. If we can wait, we’ll say that too. We don’t start treatment on growing kids earlier than necessary. Some crossbites resolve on their own as adult teeth erupt, and we monitor those at no cost.
- Treatment. Depending on the plan, this could be a palatal expander (a few months active, plus retention), full braces (12 to 24 months), Phase I followed by Phase II, or for adults, braces or clear aligners. Every visit is with Dr. Patel.
- Retention. After treatment, a retainer holds the correction in place. Crossbites have a reputation for relapse without retention. This part isn’t optional.
We think every patient deserves to see the same doctor every visit, especially for something as sensitive as bite-related treatment. That’s why we built a practice where that’s the default.
What Crossbite Treatment Costs (and How Long It Takes)
Cost ranges for crossbite treatment in the U.S. typically run:
- Palatal expander alone. $1,500 to $3,000.
- Full braces (dental crossbite only). $4,000 to $7,500.
- Expander plus full braces combination. $5,000 to $8,500.
- Adult surgical cases. Higher, and some portion may qualify as medically necessary for insurance.
These are general ranges. Your actual quote depends on complexity, insurance coverage, and treatment length. At our Cary office, we walk through the full financial picture before anyone commits. No surprise fees, no upsells mid-treatment. For more on pricing locally, see our guide to braces cost for Cary families.
Timeline-wise:
- Expansion phase. 1 to 3 months active turning, plus several months of retention.
- Braces phase. 12 to 24 months on average.
- Total crossbite plus braces treatment. Often 18 to 30 months end to end.
Frequently Asked Questions
Can Invisalign or clear aligners fix a crossbite?
For mild dental crossbites, yes. Clear aligners can shift a tipped tooth into the right position. For true skeletal crossbites where the jaw is too narrow, aligners alone usually aren’t enough. A growing child often needs an expander first, and an adult may need surgical assistance.
Will my child need surgery for a crossbite?
Almost never if it’s caught early. Surgery is typically only needed for severe skeletal crossbites in adults whose jaws have stopped growing. That’s the main reason the AAO recommends age-7 evaluations. Catching skeletal issues while the jaw is still growing usually avoids surgery entirely.
How long does a palatal expander stay in?
Active expansion (the turning phase) is usually 2 to 8 weeks. After that, the expander stays in place for several more months as a retainer while new bone fills in the gap. Total wear time is commonly 6 to 9 months.
Does a crossbite have to be fixed?
For most patients, yes, eventually. Untreated crossbites can cause uneven tooth wear, jaw shifting, gum recession, and sometimes TMJ symptoms over time. Mild cases sometimes get monitored for a few years before treatment, but they rarely resolve on their own.
Do crossbite braces hurt?
About the same as any braces treatment. Most first-week braces discomfort fades within a few days. An expander causes mild pressure during the active turning phase, but kids generally adapt within a week or two.
Can adults get treated for a crossbite without surgery?
Often, yes. If the crossbite is dental (tooth position) or mild skeletal, braces or clear aligners can usually do the job. Surgery is reserved for severe skeletal cases. The only way to know which category you’re in is a proper exam.
A crossbite caught at age 7 is almost always simpler and less expensive to fix than one caught at 17. Have questions about your child’s bite? Dr. Patel is happy to take a look, no commitment, no runaround. Book a free consultation.
About the Author
Dr. Nishant Patel, DDS, MS, Orthodontist and Founder, Tooth By Tooth Orthodontics. Dr. Patel earned his DDS from the University of Illinois at Chicago (top of his class) and his MS with orthodontic certificate from the University of Minnesota, where his research was published in the American Journal of Orthodontics and Dentofacial Orthopedics. He has over 12 years of clinical orthodontic experience and is the sole provider at Tooth By Tooth in Cary, NC. Every patient, every visit.
